Deaths from Strong Prescription Painkillers are on the Increase

Action is needed to tackle the increasing number of deaths in
the United States and Canada from prescription painkillers known as
opioids, say experts on bmj.com today.

Opioids are prescription painkillers that contain compounds
derived from the opium poppy.

While they have long been used to control the symptoms of cancer
and acute medical conditions, they are increasingly being used to
control chronic pain, for example in patients suffering from
osteoarthritis, say Dr Irfan Dhalla and colleagues at the
University of Toronto.

They describe how in the US, deaths involving opioid painkillers
increased from 4,041 in 1999 to 14,459 in 2007 and are now more
common than deaths from skin cancer, HIV and alcoholic liver
disease. They add that between 1.4 million and 1.9 million Germans
are addicted to prescription drugs and that some authorities have
suggested that the UK may face a similar epidemic to that of North
America in five to ten years time. Indeed, the use of strong
opioids for chronic non-cancer pain in the UK has been described as
a "disaster in the making" by Dr. Des Spence previously on
bmj.com.

Dr. Dhalla and colleagues add that "deaths involving methadone
and codeine roughly doubled in England and Wales between 2005 and
2009, while deaths involving heroin or morphine remained
unchanged."

In order to tackle the crisis in the US and Canada, the authors
put forward several strategies.

They say staff working for drug companies should not get
commission for marketing prescription opioid drugs and that
regulators should evaluate adverts for them before they are
disseminated. Another initiative would be to introduce real-time
electronic databases to reduce the frequency with which opioids are
obtained from multiple doctors or pharmacies.

Dhalla and colleagues also call for educational outreach
programmes for doctors to improve opioid prescribing, as well as
more research to guide practice. They note that the evidence for
the use of opioids to control chronic pain is very limited and the
risks may outweigh the benefits.

In conclusion, they say that maintaining access to opioids for
appropriately selected patients while striving for major reductions
in overdose deaths must be a major priority for physicians and
policymakers.